Provider Demographics
NPI:1508620618
Name:I V CARE OF MIDDLE GEORGIA INC
Entity Type:Organization
Organization Name:I V CARE OF MIDDLE GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-374-6662
Mailing Address - Street 1:718 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6736
Mailing Address - Country:US
Mailing Address - Phone:478-374-6662
Mailing Address - Fax:478-374-6663
Practice Address - Street 1:72 KENT RD STE 7
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1695
Practice Address - Country:US
Practice Address - Phone:478-374-6662
Practice Address - Fax:478-374-6663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I V CARE OF MIDDLE GEORGIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center